Video-assisted Surgery for Lung Cancer

Surgeons at Beth Israel Deaconess Medical Center are now offering lung cancer patients a new option in minimally invasive surgery, using a robot to assist them removing cancerous lobes.

“With the robot, you can see better because you use two high definition cameras that project a 3-D image on the screen,” says Dr. Michael Kent, Director of Minimally Invasive Thoracic Surgery at BIDMC.

“The robot itself is just a tool,” he says. “The surgeon is still the one controlling it. But the robot has seven joints within each surgical instrument. It is like a miniature human hand in the operative field.”

The operation itself- removal of the cancerous lobe- is basically done in the same way as the minimally invasive lobectomy that surgeons at BIDMC have been doing for some time, a procedure called Video Assisted Thoracic Surgery or VATS. It involves several small incisions instead of one large one that is required in the traditional open lobectomy.

The large, seven-inch incision in the back, in the area of the shoulder blade, required in open surgery “can be quite painful,” says Dr. Kent. “And the pain can be long-lasting.”

VATS allows surgeons to insert a video camera and surgical tools through smaller one-inch incisions. The length of stay in the hospital is shorter and pain is less, according to Dr. Kent.

The newly acquired robot can make the procedure more precise, he says. “We can see better. The high definition video and the instruments to do the operation are more advanced. We’re excited about it.”

The robot-assisted operation is also being done by Dr. Sidhu Gangadharan, Chief of the Division of Thoracic Surgery.

The two types of minimally invasive procedures - with or without the robot- are not necessarily used in all lung cancer operations. They are mostly used for those with early lung cancer that is not invading the rib cage or the nodes.

While Dr. Kent concedes there is no data showing robotic lobectomy is better than VATS, “it is at least a very good alternative and we think there are some advantages. It is all about what is better for the individual patient. Some operations we still do the old-fashioned way, such as when the tumor is large or the patient has previously had radiation. We are using all the tools we have available.”

Susan Byrne, 63, of Marshfield, had a robotic lobectomy in November. She says she was out of the hospital in two days.

“I’m feeling good and I’m back to work,” says the postal clerk.

A long-time smoker, she found out she had a small tumor during a CT scan offered to smokers.

She says Dr. Kent recommended the robot-assisted version of the operation and she is very satisfied.

“People look at the incisions and they can’t believe how small they are,” she says.